HEPATOGASTROENTEROLOGI

B. Rina Aninda Sidharta, dr, SpPK UNS - 2011

ANATOMI

ANATOMI
The liver consists of two main lobes - the right and the leJ, both of which are made up of thousands of lobules The liver holds about 500 ml (13 percent) of the body's blood supply at any given moment There are two disRnct sources that supply blood to the liver: Oxygenated blood ows in from the hepaRc artery Nutrient-rich blood ows in from the hepaRc portal vein

FUNGSI HATI

FUNGSI HATI

FUNGSI HATI
It provides immunity against infecRon. Hence if the liver is damaged, infecRons are more likely It is the factory for manufacturing most of the important proteins in the body, and also cholesterol and special fat forms called lipoproteins in which all body fats are carried It clears the blood of most chemicals, drugs and alcohol It excretes bile into the intesRne. Bile is vital for digesRon of fats, and also serves to throw out body wastes It regulates clo>ng of blood by manufacturing vital proteins It converts and stores extra sugar (glucose) in the form of starch (glycogen) which can be used in Rmes of starvaRon

FUNGSI HATI

FUNGSI HATI

FUNGSI HATI
Erythrocytes die aJer about 120 day and are the removed in the liver The Kuper cells( phagocyRc cells) found within the lumen of the sinusoid engulf the erythrocytes and release the haemoglobin to the hepatocytes. Haemoglobin is broken down in the Kuper cell to form haem and globin groups. The protein globin group is hydrolysed by pepRdases in the kuper cell to amino acids which are either used in protein synthesis or they are metabolised. The haem group is broken down to remove the inorganic group, Iron which is then stored in the liver. Bilirubin the other by-product of haem breakdown has no funcRonal role and is modied by the hepatocytes before being secreted as part of Bile. Bilirubin is stored in the gall bladder. AJer secreRon into the duodenum it is modied by bacteria to form Sterobilin that colours faeces. Iron is sent to the major bones for the process of haemopoiesis (blood cell formaRon).

What makes the liver unique?

All liver funcRons remain normal even if 70% of it is removed. In persons with cancer of the liver, large porRons of cancerous liver can be removed without causing harm or compromise to liver funcRon. Similarly, more than half the liver can be removed from the donor for transplantaRon purposes, without causing any derangement of liver funcRon or any other serious harm to the donor. The liver is the only organ in the body which can regenerate itself aJer large porRons of it are removed. Small remnants of liver grow back to normal size within a few weeks. This is another reason why it is safe to remove large porRons of liver from living donors and persons with liver tumours. This is also why half livers transplanted into liver failure paRents are very successful since they soon grow to normal size.

ACUTE HEPATITIS

Viral hepatitis Hepatitis A, B, C, D, and E Herpes simplex Cytomegalovirus Epstein-Barr Yellow fever adenoviruses Non viral infection toxoplasma Leptospira Q fever rocky mountain spotted fever Alcohol Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below) Ischemic hepatitis (circulatory insufficiency) Pregnancy Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE) Metabolic diseases, e.g., Wilson's disease

CHRONIC HEPATITIS
Viral hepaRRs: HepaRRs B with or without hepaRRs D, hepaRRs C (neither hepaRRs A nor hepaRRs E causes chronic hepaRRs) Autoimmune Alcohol Drugs
Autoimmune hepaRRs

methyldopa nitrofurantoin isoniazid ketoconazole

Non-alcoholic steatohepaRRs Heredity

Primary biliary cirrhosis and primary sclerosing cholangiRs occasionally mimic chronic hepaRRs

Wilson's disease alpha 1-anRtrypsin deciency

VIRAL HEPATITIS

This is the supercial epigastric vein, which drains into the external iliac vein/ caput medusa

This skin-reddening, or erythema, is indicaRve of a build up of unmetabolised chemicals in the body

PANCREAS

RANSON CRITERIA
At admission: age in years > 55 years white blood cell count > 16000 /mcL blood glucose > 11 mmol/L (>200 mg/dL) serum AST > 250 IU/L serum LDH > 350 IU/L AKer 48 hours: haematocrit decrease > 11.3444% increase in BUN of 1.8 or more mmol/L (5 or more mg/dL) aJer IV uid hydraRon hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL)) hypoxemia (PO2 < 60 mmHg) base decit > 4 Meq/L esRmated uid sequestraRon > 6 L

LABORATORY EXAMINATION
Amylase and lipase, serum calcium, glycosuria
Elevated serum AMYLASE and LIPASE levels, in combinaRon with severe abdominal pain, oJen trigger the iniRal diagnosis of acute pancreaRRs.

Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days aJer treatment. Serum amylase may be normal (in 10% of cases) for cases of acute or chronic pancreaRRs (depleted acinar cell mass) and hypertriglyceridemia. Reasons for false posiRve elevated serum amylase include salivary gland disease (elevated salivary amylase) and macroamylasemia. If the lipase level is about 2.5 to 3 Rmes that of amylase, it is an indicaRon of pancreaRRs due to alcohol.[6]
DECREASED serum Calcium Glycosuria